Right Ventricular Systolic Function Research Articles

Immediate and Short-Term Outcome of Percutaneous Trans-Catheter Device Closure of Atrial Septal Defects in Adults

Abstract Background Atrial septal defect (ASD) is one of the most common types of congenital heart defects, occurring in about 25% of children. ASD comprises 6–10% of all congenital heart defects. Included in this group of malformations are several types of atrial communications that allow shunting of blood between the systemic and the pulmonary circulations. ASDs are the most common form of acyanotic congenital heart disease. Objectives The aim of the study is to evaluate the immediate and short-term outcome of transcatheter ASD closure on cardiac functions and functional capacity in adults. Patients and Interventions This was a prospective study which recruited all adult patients undergoing secundum ASD closure between April 2023 and December 2023. Investigations included 12 surface ECG, 2D Echocardiography and assessment of functional capacity as being assessed by 6-minute walk test. These investigations were performed preprocedural, postprocedural and at one month follow up. Results Fifty patients, age ranging from 18 to 62, were divided into two groups: group 1 included 25 patients, age ranging from 18 to 40 years, while group 2 included 25 patients older than 40 years old, underwent successful transcatheter closure of ASD. There was a highly significant reduction in right ventricular (RV) and right atrial (RA) volume as being assessed by RV end diastolic volume index, RV basal diameter, and RA volume index. Also, there was a significant reduction in RV systolic function as being assessed by RV fractional area change (FAC). Furthermore, there was a highly significant reduction in Right ventricular systolic pressure (RVSP) and mean pulmonary artery pressure (mPAP). Also, there was a significant improvement of functional capacity as being assessed by 6-minute walk test distance (6 MWTD). Between the 2 groups, the results of our study showed that there was a significant difference in the postprocedural percentage of reduction in mPAP between group 1 and group 2, ΔmPAP 3.45(3.03-11.11) in group 1 and ΔmPAP 11.76 (7.14 – 16.67) in group 2 with p value of 0.001 which shows more reduction in mPAP in group 2 in comparison to group 1. Also, there was a significant difference in percentage of reduction in mPAP between group 1 and group 2 at 1 month follow up, ΔmPAP 6.9(6.06-13.04) in group 1 and 14.81 (8.82 – 20.59) with p value of 0.001 which shows more reduction in mPAP in group 2 in comparison to group 1. It was observed that there was significant difference in improvement of functional capacity as being assessed by 6MWTD at one month follow up between group 1 and group 2, Δ 6MWTD was 3.52 (2 – 6.38) in group 1 and 6.67 (5.54 – 9.21) in group 2 with P value of 0.008 which shows more improvement in functional capacity in group 2 in comparison to group 1 as seen in the next table. Conclusions Our study indicates that transcatheter closure of ASD results in promising cardiac remodeling and early significant improvement in right ventricular dimensions and functional class in adults

Role of Speckle Tracking in Detection and Short Term Follow Up of Right Ventricular Systolic Dysfunction in Patients with Acute Inferior STEMI

Abstract Background The right ventricle (RV) is a thin-walled chamber characterized by functioning under low oxygen demands and pressure. RV is perfused throughout the cardiac cycle in both systole and diastole. These factors make RV less susceptible to infarction compared to the left ventricle. Successful primary PCI in patients with RV infarction has shown to regain the RV systolic function and is associated with better in-hospital morbidity and mortality. Speckle tracking derived strain provides accurate assessment of the RV global and segmental myocardial function. Objective To assess RV systolic function in inferior STEMI using 2D echocardiography speckle tracking derived longitudinal strain early after primary PCI and follow up 3 months later. Methods This prospective cohort study was conducted at Ain Shams University Hospitals. 50 patients underwent successful (PCI) after inferior STEMI. Another 50 healthy individuals were examined “to obtain reference values for RV FWS”. Results RV function parameters showed good prognosis 3 months after primary PCI: TAPSE (39 patients “78%” showed improvement Vs 11 “22%” that had no change), also Fractional area change (FAC) (42 patients “84 %” improved Vs 8 non improved patients “16%”) finally Free wall strain showed the better improvement (44 patients “88 %” improved). Conclusion Among the echo Doppler parameters, FAC and. RV speckle tracking derived strain parameters were the most sensitive in assessment of RV function impairment and recovery after inferior STEMI.

Study of Assessment of Right Ventricular Function by 3D Echocardiography in Healthcare Workers Recovered from COVID-19 Infection

Abstract Background Right ventricular dysfunction (RVD) has been described as a potential predictor of poor outcomes in small preliminary studies, but its prevalence and associated outcomes in patients with COVID-19 are far from being elucidated. Visual examination is the most commonly used method to quantify right ventricular function (RVF). So far, the problem for echocardiographers was the unreliable estimation of RVEF via 2D echocardiography since it is not able to calculate true volumes. This limitation is overcome with 3D echocardiography, which does not rely on geometric assumptions but calculates true 3D volumes. The RVEF derived by 3D echocardiography proved to be an independent predictor of adverse cardiovascular outcomes in patients with various cardiovascular diseases. Aim of study: To assess Right ventricular functions and dimensions using 3D echocardiography in health care workers recovered from COVID-19 infection. Patients and Methods This study has been conducted in Ain Shams University Hospitals on 50 adult health care workers recovered from Proved (+VE PCR)COVID 19 infection at least 4-8 weeks prior to the study. All the included health care workers were either having history of mild or moderate COVID 19 infection. The patients were recruited during the period from septemper 2022 to march 2023. The entire study population was evaluated via 2D & 3D echocardiography. Results Our study assessed the RV functions and volumes using 2D & 3D echocardiography. The results of our study showed that RV systolic function as being assessed by FAC was found to be normal in 39 patients (78.0%) and impaired in 11 patients (22.0%). TAPSE was found to be normal in 42 patients (84.0%) and impaired in 8 patients (16.0%). While peak systolic velocity (S`) was found to be normal in 40 patients (80.0%) and impaired in 10 patients (20.0%). Among the 50 studied patients, there were 32 affected patients (64.0%) vs 18 normal patients (36.0%) as being assessed by RVEF. From the affected 32 patients by 3D Echo, 21 nurses were affected (65.6%) while 11 doctors only were affected (34.4%) and this was statistically highly significant with P value ≤0.001. In the affected patients, the mean duration from the infection was 11 months while it was 16 months in the normal patients and this was statistically highly significant with P value ≤ 0.001. From the affected 32 patients, there were 17 patients having chest pain during the infection (53.1% of the affected patients) while 4 patients only had chest pain durin the infection and normal RV function by 3D Echo (22% of the normal patients) and this was statistically significant with P value 0.034. From the normal 18 patients, there were 12 patients having fever (66.7%) while there were 11 affected paients having fever from the the total 32 affected patients (34.4%) and this was statistically significant with P value 0.02. Conclusion We concluded that the RV function is significantly impaired in the post-COVID health care workers. It is found that the 3D Echo is better to assess RV function and to detect the subclinical impairment as The RVEF measured by 3D Echocardiography is imapaired in 64% of patients while the RV FAC measured by 2D Echocardiography is imapired in just 22% of patients.

Prevalence and predictors of right ventricular dysfunction among adults living with HIV in northwest Nigeria.

People living with the human immunodeficiency virus (PLWH) are at increased risk of cardiovascular diseases. Right ventricular (RV) function has important prognostic value in cardiac pathology, and advances in imaging modalities, such as transthoracic echocardiography have enabled in-depth RV studies. There is, however, a scarcity of multiparameter RV function studies in PLWH in low- and middle-income settings, such as Nigeria. The aim of this study is to determine the prevalence and predictors of RV dysfunction among adult PLWH in northwest Nigeria. This is a retrospective cross-sectional study conducted between February 1, 2023 and August 31, 2023. We consecutively recruited 330 adults [median age 45 years, interquartile range (IQR), 38 to 52 years, 61% female] attending human immunodeficiency virus (HIV) and general outpatient clinics in a tertiary hospital in northwest Nigeria. They included 110 antiretroviral therapy (ART)-experienced PLWH, 110 ART-naïve PLWH, and 110 age- and sex-matched HIV-negative control subjects. All participants had conventional two-dimensional (2D), tissue Doppler (TDI), and speckle tracking (2D-STE) echocardiography to estimate left ventricular (LV) and RV systolic and diastolic function, peak systolic and diastolic myocardial velocities, RV and LV longitudinal strain, and chamber dimensions. All participants also underwent 12-lead electrocardiography. Multiple linear and Firth's logistic regression modeling were performed to assess for independent predictors of RV myocardial performance index (RVMPI) as a continuous and as a dichotomous variable, respectively. The prevalence of RV dysfunction, as determined by the RVMPI among HIV-positive participants was 14.5% [95% confidence interval (CI): 10.5-19.8%] compared to 0% (95% CI: 0.0-3.4%) for those without HIV. Among participants with HIV, RVMPI was associated with participant age (P<0.001) and left ventricular ejection fraction (LVEF) (P<0.001). Results were similar when RVMPI was dichotomized. The association between RV dysfunction and LVEF was modified by ART status: a 10% decrease in LVEF was associated with an average decrease of 0.08 in RVMPI among participants who were ART-experienced (β=-0.08, P<0.001) but a lesser decrease among those who were ART- naïve (β=-0.03, P=0.14). This study highlights the complexity of RV dysfunction in PLWH and underscores the importance of LVEF and age as key factors influencing the risk of RV dysfunction in PLWH.

The Relationship Between Right Ventricular Longitudinal Strain and Adverse Outcome in Hypertensive Patients: 10-year Follow-up.

Previous studies showed the importance of right ventricular (RV) remodeling in patients with arterial hypertension and RV longitudinal strain was recognized as very sensitive parameter for detection of subtle cardiac impairment. However, its clinical importance in arterial hypertension has not been established so far. The present study aimed to evaluate the association between RV longitudinal strain (global and free-wall) on adverse outcomes measured by MACE in the large group of hypertensive patients who were followed for mean period of 10 years. This retrospective study finally included 544 hypertensive patients who underwent full echocardiographic examination including 2D speckle tracking imaging. between January 2010 and December 2014. MACE was considered as the primary outcome and it was defined by all-cause mortality, cardiovascular mortality, myocardial infarction, coronary artery by-pass, coronary stent implantation, stroke, development of heart failure, and occurrence of atrial fibrillation during follow-up. Patients who experienced MACE were older than those who did not. There was no difference in demographic and clinical parameters between MACE and non-MACE patients. There was no difference in RV diameter, but MACE patients had higher RV wall thickness. RV systolic function parameters were similar between the two groups. RV global and free-wall longitudinal strain were significantly lower in MACE patients (-22.3 ± 3.6 vs. -24.7 ± 3.9%, p < 0.001 and - 25.8 ± 4.2 vs. -28.1 ± 4.5%, p < 0.001; respectively). Reduced RV GLS [OR 1.10; 95%: 1.02-1.20] and reduced RV free-wall longitudinal strain [OR 1,21; 95%CI: 1.05-1.39] were independently of clinical and echocardiographic parameters related with adverse outcome measured by MACE. RV GLS and RV free-wall longitudinal strain were independently related with adverse outcomes during 10-year follow-up in initially uncomplicated hypertensive patients.

Associations Between Echocardiographic Right Heart Measurements With Short-Term Prognosis in Heart Failure: A Prospective Study.

Echocardiographic right ventricular (RV) dysfunction is a strong risk determinant for prognosis in patients with heart failure (HF). Although parameters of RV systolic function are widely used to define RV dysfunction, there is scarce data to suggest these parameters are best suited to predict HF-related outcomes. We aimed to understand which morphologic or functional parameters are most closely associated with short-term mortality and HF-related hospitalization in patients with HF. A total of 191 patients from eight study centers were included to this study. A detailed echocardiographic examination was done at enrollment, and patients were followed up for 6 months via direct interviews or phone calls. All right-sided echocardiographic parameters other than tricuspid annular plane systolic excursion were associated with outcomes. In a proportional hazards model that included right-heart parameters, RV longitudinal diameter (HR: 1.07, 95%CI: 1.04-1.10, p<0.001), wall thickness (HR: 1.3, 95%CI: 1.13-1.50, p<0.001), and tricuspid annular systolic velocity (HR: 0.90, 95%CI: 0.82-0.96, p=0.02) were found as the independent predictors. However, only RV longitudinal dimension (HR: 1.04, 95%CI: 1.01-1.08, p=0.01) and RV wall thickness (HR: 1.32, 95%CI: 1.10-1.60, p=0.004) were associated with short-term outcomes after adjusting for other clinical and left-sided echocardiographic variables. On a Bayesian logistic regression model that included right-sided echocardiography variables, there was strong evidence for including either RV longitudinal diameter (BF10: 190.4) or wall thickness (BF10: 30.7) to the final model. Parameters of RV morphology were better predictors of short-term outcomes in HF patients.

Características de la insuficiencia tricúspide grave inducida por dispositivos de estimulación intracardiacos

Introduction and aimsTricuspid regurgitation (TR) induced by the implantation of cardiac implantable electronic devices (CIED) is an increasingly common cause of severe TR. Our aim was to describe the echocardiographic phenotypic characteristics of CIED-induced severe TR. MethodsRetrospective cohort study that included patients with severe TR related to CIED diagnosed in the cardiac imaging unit of a Spanish tertiary hospital. Results37 patients with severe TR induced by lead/electrode interference formed our study group. TR was predominantly severe (68%), followed by massive (21%) and torrential (11%). The leaflet most affected by the interference was the septal. 58% of the sample presented severe dilatation of the right atrium (RA) (mean RA area 28cm2). Mean tricuspid annulus measurement was 42mm. The usual parameters for quantifying RV systolic function were on average within the normal range (TAPSE mean 19mm, S’ wave 10mm, FAC 41%), while global RV strain (RVGLS -15%) and free wall strain (RVFWLS -19%) were found reduced. An incipient degree of ventricular/pulmonary arterial uncoupling was evident (mean TAPSE/PSAP 0.34, SGLVD/PSAP 0.27%/mmHg). ConclusionsOur patients with CIED-induced severe TR are characterized by a heterogeneous phenotype with a high prevalence of severe RA and tricuspid annulus dilatation. RVGLS, RVFWLS, and arterial ventricular coupling were the most sensitive parameters for early assessment of RV systolic dysfunction.

Role of Two Dimensional Left and Right Ventricular Speckle Tracking Echocardiography in Early Detection of Chemotherapy Induced Ventricular Systolic Dysfunction

Abstract Background Cancer and cardiovascular diseases are the main causes of mortality worldwide. Although the incidence of cancer is rising, modern comprehensive management including surgery, chemotherapy and radiotherapy led to decreased mortality and prolonged survival, but also a large spectrum of cardiovascular complications. Since mortality from patients who develop heart failure secondary to chemotherapy is as high as 60% by 2 years. Early detection of subclinical Cancer Therapeutic Related Cardiac Dysfunction (CTRCD) is of utmost importance, conventional EF measurement fails to detect subtle changes in LV function, so a more sensitive tool is needed. Objective To detect early subclinical left &amp; right ventricular dysfunction based on measurement of 2D LV &amp; RV speckle tracking derived strain values. Patients and Methods The current study is a prospective study which included 101 asymptomatic female patients with newly diagnosed breast cancer who received anthracycline ± trastuzumab based chemotherapy regimen. A comprehensive echocardiographic examination was performed to all patients prior to receiving the chemotherapy (T0), at 3 months (T1) and at 6 months after (T2). All patients had pre- treatment normal LV EF. We aimed at studying the changes in LV &amp; RV mechanics and detecting whether they can help in early prediction of cardiotoxicity. Cardiotoxicity was defined decrease in EF &amp;gt; 10% from baseline value to EF &amp;lt; 55% in asymptomatic patients or &amp;gt; 5% in symptomatic patients “as defined by the cardiac review and evaluation committee (CREC)”. Results The mean age of the study population was 48.75±10.07 years. CTRCD occurred in 24 patients (25.5%) with mean EF by Simpson`s method 59.29±3.50 % at (T0), 49.54±5.63% at (T1), 45.79±4.49% at (T2). While in non-CTRCD patients the mean EF was 60.21±2.80% at (T0), 59.13±2.53% at (T1), 58.29±2.63% at (T2). RV systolic function impairment (S`&amp;lt;10 cm/s) was more prevalent occurring in 37 patients representing 39.4% of the study population. By univariate and multivariate regression analysis LV GLS at (T1) (cut-off value &amp;lt;-15% with relative 12.5% reduction from the baseline value) was a strong predictor of CTRCD, but combining LV GLS with RV GLS &amp; RV FWLS was the strongest (AUC=0.947, sensitivity=91.67%, specificity=90%). Conclusion Anthracycline ± Trastuzumab treatment leads to changes in LV &amp; RV mechanics with more prevalent deterioration in RV values. Presence of lower LV &amp; RV strain values at the base line together with reduction of these values after chemotherapy treatment both can predict later development of CTRCD. Combining LV GLS with RV GLS &amp; FWLS values at (T1) is the strongest predictor of subsequent CTRCD.

Assessment of right ventricular sequelae by speckle tracking echocardiography in recovered COVID-19 patients

Background TTE is the main modality used to assess RV function, but conventional TTE parameters have limited diagnostic value because they may fail to detect early abnormalities in RV systolic function. Due to its ability to detect subclinical impairment of cardiac function, 2D STE has been widely used to investigate RV function. In this study, we aimed to investigate whether there are sequelae of RV function in recovered COVID-19 patients with pulmonary involvement. Methods This is a prospective observational cohort study of 57 healthy volunteers and 54 patients. Participants had no history of chronic illness and no evidence of respiratory or cardiac symptoms. The patients had been hospitalised with COVID-19 with pulmonary involvement but did not require intensive care unit follow-up or non-invasive mechanical ventilation support. TTE was performed. Demographic and clinical characteristics and laboratory test results were collected. Results LVEF, TAPSE, St and FAC were significantly lower in the patient group. LV-LS 3-chamber, LV-GLS, RV-FWS, RV-GLS were significantly lower in the patient group. Conclusions RV-LS and LV-GLS were shown to decrease in the patient group. Although no obvious pathological values were observed in RV parameters on conventional echocardiography, TAPSE, St and FAC values were lower in the patient group.

The effects of percutaneous branch pulmonary artery interventions in biventricular congenital heart disease: study protocol for a randomized controlled Dutch multicenter interventional trial

BackgroundBranch pulmonary artery (PA) stenosis is one of the most common indications for percutaneous interventions in patients with transposition of the great arteries (TGA), tetralogy of Fallot (ToF), and truncus arteriosus (TA). However, the effects of percutaneous branch PA interventions on exercise capacity remains largely unknown. In addition, there is no consensus about the optimal timing of the intervention for asymptomatic patients according to international guidelines. This trial aims to identify the effects of percutaneous interventions for branch PA stenosis on exercise capacity in patients with TGA, ToF, and TA. In addition, it aims to assess the effects on RV function and to define early markers for RV adaptation and RV dysfunction to improve timing of these interventions.MethodsThis is a randomized multicenter interventional trial. TGA, ToF, and TA patients ≥ 8 years with a class IIa indication for percutaneous branch PA intervention according to international guidelines are eligible to participate. Patients will be randomized into the intervention group or the control group (conservative management for 6 months). All patients will undergo transthoracic echocardiography, cardiac magnetic resonance (CMR) imaging, and cardiopulmonary exercise testing at baseline, 6 months, and 2–4 years follow-up. Quality of life (QoL) questionnaires will be obtained at baseline, 2 weeks post intervention or a similar range for the control group, and 6 months follow-up. The primary outcome is exercise capacity expressed as maximum oxygen uptake (peak VO2 as percentage of predicted). A total of 56 patients (intervention group n = 28, control group n = 28) is required to demonstrate a 14% increase in maximum oxygen uptake (peak VO2 as percentage of predicted) in the interventional group compared to the control group (power 80%, overall type 1 error controlled at 5%). Secondary outcomes include various parameters for RV systolic function, RV functionality, RV remodeling, procedural success, complications, lung perfusion, and QoL.DiscussionThis trial will investigate the effects of percutaneous branch PA interventions on exercise capacity in patients with TGA, ToF, and TA and will identify early markers for RV adaptation and RV dysfunction to improve timing of the interventions.Trial registrationClinicalTrials.gov NCT05809310. Registered on March 15, 2023.

Serial Changes in Ventricular Strain in Symptomatic Obstructive Hypertrophic Cardiomyopathy Treated With Mavacamten: Insights From the VALOR-HCM Trial.

In severely symptomatic patients with obstructive hypertrophic cardiomyopathy, VALOR-HCM (A Study to Evaluate Mavacamten in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy Who Are Eligible for Septal Reduction Therapy) demonstrated that mavacamten reduces the need for septal reduction therapy with sustained improvement in left ventricular (LV) outflow tract gradients and symptoms. Global longitudinal strain (GLS), a measure of regional myocardial function, is a more sensitive marker of systolic function. In VALOR-HCM, we assessed serial changes in LV and right ventricular (RV) strain. VALOR-HCM included 112 patients with symptomatic obstructive hypertrophic cardiomyopathy (mean, 60 years; 51% male; LV ejection fraction, 68%). Patients assigned to mavacamten at baseline continued the drug for 56 weeks (n=56) and those assigned to placebo (n=52) transitioned to mavacamten from weeks 16 to 56 (40-week exposure). LV-GLS and RV-GLS assessment was performed using a vendor-neutral software. Non-foreshortened apical (4-, 3-, and 2-chamber) views were used to obtain peak LV-GLS. RV focused 4-chamber view was used to calculate RV 4-chamber and free wall strain. A more negative strain value is favorable. At baseline, the mean LV-GLS, RV 4-chamber, and free wall strain values were -14.7%, -22.2%, and -16.8%, respectively (all worse than reported normal means). In the total study sample, LV-GLS significantly improved from baseline to week 56 (P=0.02). Twelve patients had transient reduction in LV ejection fraction (<50%) requiring temporary drug interruption (including 3 permanent discontinuations). The LV-GLS in this subgroup was worse at baseline versus total study population (-11.4%), with no significant worsening from baseline through week 56 (P=0.64). Both free wall and 4-chamber RV-GLS remained unchanged from baseline to week 56 (P=0.62 and P=0.56, respectively). In VALOR-HCM, treatment with mavacamten improved LV-GLS from baseline through week 56 (with no significant worsening of LV-GLS in patients with a reduction in LV ejection fraction ≤50%), suggesting a favorable long-term impact on regional LV systolic function. Additionally, there was no detrimental impact on RV systolic function. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04349072.

O07 RENAL DENERVATION IMPROVES RIGHT VENTRICULAR FUNCTION, RESTORES MYOCARDIAL NOREPINEPHRINE LEVELS AND REVERSES VENTRICULAR SPECIFICITY OF SELECTED MARKERS IN HYPERTENSIVE RATS WITH HEART FAILURE INDUCED BY VOLUME OVERLOAD

Background and objective: Despite the known anti-hypertensive effect of renal denervation (RDN), its influence on the cardiac function, particularly of the right ventricle (RV) and the cardiac sympathetic nervous system in heart failure (HF) is poorly understood. This study aimed to investigate the effect of RDN on RV function, myocardial norepinephrine (NE), and left versus right ventricular (LV/RV) dominance of HF markers in HF induced by aorto-caval fistula (ACF). Methods: ACF was created in hypertensive Ren-2 transgenic rats. RDN was performed by phenol application. Cardiac function was measured by echocardiography and pressure-volume analysis. NE levels were measured using an ELISA kit, protein expression was assessed by western blotting, gene expression by TaqMan PCR assay, and ROS by Amplex Red assay. Results: RDN in ACF rats decreased RV hypertrophy and dilatation, decreased RV end-systolic pressure and end-diastolic pressure, improved RV function (Ees +45%, FAC +20%), decreased HF gene markers Nppa, Tgm2, Myh7/6 ratio, and increased SOD2 protein expression. RDN decreased plasmatic NE levels, increased NE in RV, and decreased monoamine oxidase (MAO-A) in RV. NE levels and SOD2 were more dominant in RV than LV in control (sham/intact) rats and ACF changed their specificity towards RV dominance, while RDN had no effect in these parameters in ACF on ventricular specificity. In sham/intact rats dominant for LV were hemodynamic parameters Ees, EDPVR, and molecular markers Mao-a, ROS production by MAO-A, Nppa, Myh7, Myh7/6 ratio, Tgm2, Uchl1, and Beta1/Chrm2 ratio. ACF changed the dominance of these selected markers from LV to RV. Interestingly, RDN reversed dominance back towards LV in gene markers Mao-a, Nppa, Myh7, Tgm2, Uchl1, and Beta1/Chrm2 ratio. Conclusions: RDN decreased RV ESP and EDP, improved RV systolic function, restored NE levels, decreased RV gene expression of selected HF markers, and reversed their RV/LV dominance, probably by reduction of central sympathetic nerve drive and alternations of the cardiac sympathetic nervous system.

Intraoperative right ventricular end-systolic pressure–volume loop analysis in patients undergoing cardiac surgery: A proof-of-concept methodology

BackgroundPerioperative right ventricular (RV) dysfunction is associated with increased morbidity and mortality in cardiac surgery patients. This study aimed to demonstrate proof of concept in generating intraoperative RV pressure–volume (PV) loops and conducting an end-systolic PV relationship (ESPVR) analysis using data obtained from routinely used intraoperative monitors. MethodsAdult patients undergoing cardiac surgery with the placement of a pulmonary artery catheter (PAC) between May 2023 and March 2024 were included prospectively. The PV loops were generated using 3-dimensional echocardiographic RV volume data and continuous RV pressure data obtained from a PAC. The volume–time and pressure–time curves were digitized using the semiautomatic WebPlotDigitizer program and synchronized to reconstruct an RV PV loop and analyze ESPVR using the previously validated single-beat method. ResultsIntraoperative RV PV loops were generated for 25 patients, including 17 patients with preserved RV systolic function (group 1) and 8 patients with reduced systolic function (group 2). Mean Ees, Ea, and Ees/Ea ratio were 0.63 ± 0.25 mm Hg/mL, 0.60 ± 0.23 mm Hg/mL, and 1.0 8 ± 0.31 mm Hg/mL, respectively, by the Pmax method and 0.56 ± 0.32 mm Hg/mL, 0.60 ± 0.23 mm Hg/mL, and 0.91 ± 0.21 mm Hg/mL, respectively, by the V0 method. Group 1 had a significantly higher Ees compared to group 2 regardless of the calculation method and a larger Ees/Ea ratio calculated by the V0 method. ConclusionsIt is clinically feasible to derive RV PV loops from routine hemodynamic and echocardiographic data. With further validation and technological support, this can be a potential real-time intraoperative RV function monitoring tool.

Impact of regional anesthesia on left and right ventricular performance after off-pump coronary artery bypass grafting: randomized controlled study

Introduction. New anesthesia techniques require evidence of the safety of their implementation, however there is still the opinion about negative impact of regional anesthesia on heart performance and central hemodynamics. The objective of our study was to evaluate effect of regional anesthesia on systolic and diastolic myocardial function in off-pump coronary artery bypass grafting (OPCAB).Materials and methods. A prospective randomized controlled trial included 45 patients who underwent elective OPCAB, equally divided into 3 groups – general anesthesia in combination with epidural anesthesia (GA+EA), general anesthesia with erector spinae plane block (GA+ESPB) and general anesthesia without regional anesthesia (GA). The systolic function of the left (LV) and right ventricle (RV), as well as the diastolic function of the LV were evaluated during five stages perioperatively, using echocardiography and thermodilution via Swan-Ganz catheter.Results. There were no intergroup differences in parameters of LV or RV systolic function and LV diastolic function during study stages. Perioperatively, there was a decrease in LV end-diastolic volume in the groups of OA+ESPB (p = 0.001) and OA (p = 0.003).At the end of the first postoperative day (POD), pulmonary artery wedge pressure decreased in the groups of OA+EA (p = 0.003) and OA+ESPB (p = 0.008); meanwhile, ejection time (p = 0.003) and velocity-time integral (p = 0.005) from RV reduced only in the OA+ESPB group. In the OA+EA group at the end of POD1, the reservoir strain of left atrium (p = 0.022) and isovolumic relaxation time (p = 0.006) decreased.Conclusion. In OPCAB, epidural anesthesia and ESPB do not result in deterioration of LV systolic and diastolic function and do not have a negative impact on the RV.

Fetal Right Heart Strain in Systemic Right Ventricles and Impact on Post-surgical Outcomes.

Patients with hypoplastic left heart syndrome (HLHS) and its variants rely on the right ventricle (RV) to provide cardiac output. Diminished RV systolic function has been associated with poor clinical outcomes in this population. Echocardiographic strain has emerged as a useful method to quantify RV deformation. We aimed to describe fetal strain in the systemic RV and further investigate if there was any correlation with clinical outcomes. We conducted a retrospective, single center study evaluating strain in fetuses with systemic RV. We measured fetal RV global longitudinal strain (GLS) and segmental strain using Tomtec 2D speckle tracking software and compared these findings to controls. Fifty patients with systemic RV were included in the study group with controls matched one to one for each echocardiogram. Ten patients died after first-stage palliation. GLS was reproducible, with interobserver ICC 0.82. There was no statistically significant difference in GLS among different HLHS subtypes. Abnormal GLS did not correlate with worse clinical outcomes. GLS in systemic RVs in the 2nd and 3rd trimester did not vary significantly throughout gestation and did not correlate with clinical outcomes. Risk factors associated with poor outcome were mainly postnatal. Multi-centered studies are needed to determine if these findings hold true in a larger sample size.

Assessment of right ventricular systolic function using speckle tracking strain imaging in patients with severe tricuspid regurgitation: a validation study with cardiac magnetic resonance

BackgroundRight ventricular (RV) systolic dysfunction is an established prognostic factor in patients with severe tricuspid regurgitation (TR). However, accurate assessment of RV systolic function using conventional echocardiography remains challenging. We investigated the accuracy of strain measurement using speckle tracking echocardiography (STE) for evaluating RV systolic function in patients with severe TR.MethodsWe included consecutive patients with severe TR who underwent echocardiography and cardiac magnetic resonance imaging (CMR) within 30 days between 2011 and 2023. Two-dimensional STE was used to measure RV free wall longitudinal strain (RVFWLS) and global longitudinal strain (RVGLS). These values were compared with the RV ejection fraction (RVEF) from CMR. RV systolic dysfunction was defined as a CMR-derived RVEF < 35%.ResultsA total of 87 patients with severe TR were identified during the study period. Among echocardiographic RV strain measurements, RVFWLS was the best correlate of CMR-derived RVEF (r = –0.37, P < 0.001), followed by RVGLS (r = –0.27, P = 0.012). Receiver operating characteristic (ROC) curve analysis revealed that RVFWLS provided better discrimination of RV systolic dysfunction, yielding an area under the ROC curve (AUC) of 0.770 (95% confidence interval [CI], 0.696–0.800) than RV fractional area change (AUC, 0.615; 95% CI, 0.500–0.859).ConclusionsIn patients with severe TR, STE-derived RVFWLS showed the best correlation with RVEF on CMR and displayed superior discrimination of RV systolic dysfunction compared with the RV fractional area change. This study suggests the potential usefulness of STE in assessing RV systolic function in this population.

Abstract Tu057: Renal denervation enhances right ventricular function, reduces myocardial damage, and restores myocardial sympathetic signaling in rats with heart failure induced by volume overload

Introduction: Heart failure (HF) is associated with chronically increased sympathetic nervous activity with depleted norepinephrine (NE) in the myocardium. Despite the known anti-hypertensive effect of renal denervation (RDN), its influence on the function of the right ventricle (RV) and the cardiac sympathetic nervous system in HF is not well comprehended. Hypothesis: RDN improves RV function by reducing central sympathetic drive and changes of a sympathetic nervous branch in the heart. Aims: To investigate the effect of RDN on RV function, HF markers, myocardial NE, and its metabolism in RV in HF induced by aorto-caval fistula (ACF). Methods: HF was induced by ACF in Ren-2 transgenic rats (TGR). One week later, the RDN was performed by phenol application. Two weeks after RDN, RV function was measured by pressure-volume analysis and RV tissue was collected. Echocardiography was done once a week, during the entire experiment. NE levels were measured using an ELISA kit, protein expression was assessed by western blotting, gene expression by TaqMan PCR gene expression assay, and ROS by oxidation of Amplex Red assay. Results: The ACF increased RV weight, RV dimensions (RVD1, RVD2, RVD3), end-systolic (ESP) and end-diastolic pressure (EDP), reduced RV systolic function (end-systolic elastance - Ees, fractional area change - FAC) and ventricular-arterial coupling (Ees/Ea ratio), increased gene expression of HF markers collagen I/III ratio, natriuretic peptide A (Nppa), myosine heavy chain 7/6 (Myh7/6) ratio, transglutaminase 2 (Tgm2), and decreased superoxide dismutase 2 (SOD2) protein expression. ACF increased plasmatic NE levels, depleted NE in RV, decreased tyrosine hydroxylase protein expression in RV, and increased gene, protein expression, and activity of monoamine oxidase A (MAO-A). RDN decreased RV hypertrophy and dilatation (RVD1, RVD2, RVD3), decreased RV ESP (-7 mmHg, p=0.004) and EDP (-2.2 mmHg, p=0.003), improved RV function (Ees +45%, p=0.03, FAC +20%, p=0.005, Ees/Ea ratio +46%, p=0.02), decreased HF markers collagen I/III ratio, Nppa, Tgm2, Myh7/6 ratio, and increased SOD2 protein expression. RDN decreased plasmatic NE levels, increased NE in RV (+32%, p=0.03), and decreased MAO-A in RV. Conclusions: RDN decreased RV ESP and EDP, improved RV systolic function, restored NE levels, and decreased RV gene expression of selected HF markers, probably by reduction of central sympathetic nerve drive and alterations of the cardiac sympathetic nervous system.

Abstract Tu051: ROR2 Drives Right Ventricular Failure Via Proteostatic Imbalances

Background: No therapies exist to treat right ventricular failure (RVF), in part because RVF molecular drivers have been incompletely studied. We recently identified that the developmentally restricted noncanonical WNT receptor ROR2 is re-expressed in a severity-dependent manner in human RVF. Here we test in mice if, and how, the re-expression of Ror2 causes RVF. Methods/Results: We find in neonatal rat ventricular myocytes (NRVMs) that Ror2 overexpression (Ror2 OE ) both activates protein translation and reduces Hspa1a/b mRNA and Hsp70 protein, resulting in increased protein turnover, fragmented sarcomeres, intercalated disc disruption, reduced cell major axis, impairment of contractile and relaxation kinetics, and ectopy. Ror2 knockdown (Ror2 KD ) results in opposing phenotypes. Hsp70 overexpression or proteasome inhibition rescues many of the Ror2 OE phenotypes, demonstrating their causal involvement. NRVM proteomic analysis indicates that Ror2 OE activates an ERK/p90RSK/Eef2 pathway that is known to regulate translation extension. In vivo, cardiac Ror2 OE in mice causes RV dilation and dysfunction, intercalated disc disruption, reduced Hspa1b (encoding for Hsp70), proteasome activation, and reduced cardiomyocyte ubiquitin staining. The mouse pulmonary artery banding (PAB) model of RVF reveals similar Ror2 induction and proteasome activation. Ror2 KD by AAV9 in PAB reduces RV dilation and improves RV systolic and diastolic function. Finally, in cardiac samples from human RVF, we find evidence for a similar ROR2-responsive proteostatic imbalance with increased proteasome activity and ubiquitin as well as markers of increased ERK and p90RSK. Conclusions: ROR2 is induced in human and mouse RVF, and mechanistic studies in NRVMs and mice show that the induction of ROR2 causes RVF by disrupting the proteostatic balance of translation, folding, and turnover. Knockdown or suppression of ROR2 may serve as a novel RVF therapeutic target.

Abstract Tu059: Single-Nucleus Transcriptomics Demonstrates Endothelial Cell Expansion in Failing Human Right Ventricles

Background: Right ventricular failure (RVF) is most commonly observed as a sequela of left ventricular failure (LVF)—for which it more than doubles the risk of mortality. Moreover, isolated RVF is the most common cause of death in pulmonary hypertension and is a leading cause of major adverse events in systemic right ventricle congenital heart diseases. Therapies which effectively treat LVF show poor efficacy for RVF. For example, beta blockade, a cornerstone of LVF therapy, has no efficacy in RVF. Therefore, there is a need for broader exploratory research to identify pathways which are dysregulated in RVF and which could serve as targets for future therapies. Methods/Results: To this end, we performed single-nucleus RNA sequencing (N=11) on RV myocardium from nonfailing or dilated cardiomyopathy (DCM) hearts subgrouped by preserved systolic and diastolic RV function (pRV) or RVF. After cell-type assignment and differential expression analysis, we find a progressive upregulation of pro-angiogenic signaling in vascular endothelial cells (ECs) from nonfailing to pRV and RVF. There is a concomitant expansion of the EC pool from nonfailing to pRV and RVF (EC percentage 5%, 9%,15% for NF, pRV, and RVF; p &lt; 0.05 for one-way ANOVA). We find increased HIF-mediated and VEGF-mediated signaling in these ECs, which may be mediating this expansion. Surprisingly, there is also increased expression of genes regulated by type 1 interferon signaling, which is thought to be anti-angiogenic. Discussion: In summary, we have conducted a single-nuclei transcriptomic study of human RVF and found evidence for increased angiogenic signaling and EC expansion. These findings are significant, as the balance of pro-angiogenic and anti-angiogenic factors in RVF is still unclear, with studies in animal models showing conflicting results in terms of changes in macro/microvasculature in RVF. Here, we provide evidence that in human RVF the balance tends to lead toward a pro-angiogenic phenotype, even in dysfunctional RVs. Orthogonal studies to validate the causal nature of these observed changes in pathogenesis of RVF are currently ongoing.

Abstract Tu065: The role of heavy metals in pulmonary arterial hypertension pathogenesis

Pulmonary arterial hypertension (PAH) is a disease where chronic high pulmonary arterial pressure causes inflammation, remodeling, and dysfunctions of lung endothelial/smooth muscle cells, and right ventricle (RV) cardiomyocytes. Pathogenesis is caused by a mixture of genetic, epigenetic, and environmental factors. Our clinical studies found PAH patients had elevated cadmium (Cd) and antimony (Sb) levels in the blood and/or urine, which correlated with increased severity of PAH parameters. Thus, we hypothesize that environmental factors, specifically chronic heavy metal exposure, could contribute to PAH pathogenesis either directly or indirectly. We tested if Cd could induce PAH or worsen PAH parameters in the mouse SU5416 and hypoxia (SuHx) PAH model. Forty male C57/6J mice were initially split in 2 groups: control and 5ppm Cd in drinking water (n=20/each) for 8 weeks (wks). Diastolic and systolic functions were evaluated with echocardiography (echo) at baseline, and 8ks. Then, half of these mice were subject to PAH induction, netting 4 subgroups (n=10/group): CTRL, Cd, PAH, and Cd+PAH. Echo was performed again 4 wks post-PAH induction, followed by RV systolic pressure (RVSP) measurement (n=3/group). The remaining 7 mice/group were euthanized for heart/lung histopathology focusing on fibrosis and hypertrophy, and protein western blot analyses. GraphPad Prism 8 software was used for statistical analysis with normality checked. When data did not follow normality, the non-parametric equivalence was used. Two-way and one-way ANOVA with Tukey were performed for echo/RVSP and histological/biochemical analyses respectively, with a p-value&lt;0.05 being significant. Results showed 12-wks Cd exposure alone caused: (1) significantly increased RV systolic function indicating systolic stimulation, and (2) significantly increased collagen contents in both ventricles and LV cardiomyocyte area when compared to CTRL. Twelve-wks Cd+PAH group demonstrated (1) significantly decreased RV cardiac output and RVSP measurements indicating RV failure; (2) no further RV changes in collagen contents or hypertrophy; (3) LV western blot analysis revealed significant upregulation of antioxidant proteins, including catalase and superoxide dismutase 2, when compared to PAH group. Further mechanistic experiments are being conducted, including whether Sb has similar results as Cd.